Traditional Transvaginal Cerclage (TVC)

To prevent a premature birth, your doctor may recommend a traditional transvaginal cerclage, also known as a cervical stitch. A traditional transvaginal cerclage (TVC) is a surgical procedure performed within the first 12 to 14 weeks of pregnancy where the cervix is sewn closed. The procedure has a success rate of 80 to 85 percent in bringing babies to viability. However, women who receive this procedure will need to be checked routinely during pregnancy for complications such as infection or preterm labor.

During the procedure, women will receive an epidural or anesthesia for pain control. Next, a doctor will stitch a strong thread around the cervix to hold it firmly closed. After the procedure, you’ll remain in the hospital for a few hours or overnight. Immediately following the procedure, you may experience light bleeding and vaginal discharge. It is recommended to refrain from physical activity for two to three days after the procedure. The cerclage will remain on the cervix until the 37th week of pregnancy and will be removed before your water breaks or contractions begin.

McDonald’s Cerclage

A McDonald’s cerclage is the most common procedure for an incompetent cervix. The procedure consists of using a pure string stitch to suture the upper part of the cervix. When this procedure is done, the lower part of the cervix is already effaced and a doctor’s knot is made in the front of the cervix.

The advantages of the McDonald’s cerclage is it can be performed relatively quickly, there is minimal bleeding, and the suture can be more easily removed for vaginal delivery. However, one of the disadvantages of this procedure is the suture sometimes isn’t placed highly or deeply enough on the cervix.

Shirodkar Cerclage or Modified Shirodkar Cerclage

A Shirodkar cerclage is another common procedure for an incompetent cervix. This procedure involves the dissection of the vaginal mucosa and bladder. The cervix is pulled down and the bladder is pushed up above the internal OS. The suture is then placed as high as possible around the cervix through the cervical stroma. The suture can be placed anteriorly and tied posteriorly or placed posteriorly and tied anteriorly.

The advantage of this procedure is the suture is placed much higher than the McDonald’s cerclage. However, many doctors may avoid this technique for fear of damaging the bladder or incorrect placement because of how high the suture is placed.